PB2353: HEALTHCARE RESOURCE UTILIZATION AND COSTS OFF THERAPY WITH FIXED-DURATION VENETOCLAX AMONG CLL PATIENTS
Authors: J. N. Allan, A. P. Skarbnik, N. Emechebe, H. Alhasani, B. S. Manzoor
Journal: HemaSphere (2022)

Background: Treatment with fixed-duration venetoclax regimens are approved in first-line (1L) and relapsed/refractory (RR) settings for patients with chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL). While studies have described fixed treatment duration (FTD) in the context of clinical trials or total cost of care, there’s a paucity of data that characterize the real-world benefits of FTD with venetoclax therapy. Aims: This study aims to quantify the healthcare resource utilization (HRU) and costs, during and post-completion of therapy, with venetoclax plus obinutuzumab (VO) or venetoclax plus rituximab (VR). Methods: Patients diagnosed with CLL/SLL between 1/1/2010 – 6/30/2020 that were at least 18 years old and initiated VO in the 1L or VR in RR were identified in Optum Clinformatics database. Patients were required to be continuously enrolled in their health plan one year pre- and post-initiation with VO or VR. The follow-up period was split into two phases: 1) on-treatment phase (time in months from VO/VR initiation to end of treatment) and 2) off-treatment phase (time in months from one day after end of venetoclax treatment to end of continuous enrollment/one day before next line of therapy). Per-patient, per-month (PPPM) all-cause HRU and costs were summarized using mean, standard deviation (SD), median, and interquartile range (IQR) in both on- and off-treatment phases. Results: A total of 108 patients (VO=46; VR=62) were identified with a median age of 71 years and 30.6% female. In 1L, the median (IQR) duration of the on- and off-treatment phases were 12.3 (11.1 – 14.1) and 7.5 (3.3 – 10.3) months, respectively. Mean PPPM all-cause costs were $18,552 and $2,837 in the on- and off-treatment phases, respectively. The on-treatment costs were largely driven by medication costs ($15,203 PPPM) compared to medical costs ($3,349 PPPM). Conversely, medical costs ($2,124 PPPM) accounted for the majority of total costs off-treatment. The mean PPPM all-cause outpatient visits were slightly higher in the on vs off-treatment phases (3.3 and 2.3 visits), respectively. In RR, the median (IQR) duration of the on- and off-treatment phases were 17.6 (12.2 – 23.7) and 2.3 (0.5 – 6.9) months. Mean PPPM all-cause costs were $17,061 and $1,889 in the on- and off-treatment phases, respectively. Similar to the VO cohort, medication costs ($13,887) accounted for a majority of the total cost in the on-treatment phase while medical costs ($1,273) were the primary drivers of cost in the off-treatment phase. Furthermore, the mean PPPM all-cause outpatient visits were higher in the on-treatment phase (3.2 vs 1.4). Summary/Conclusion: This study illustrates that in real-world practice settings, reduced HRU and cost burden was observed with venetoclax combination regimens. These preliminary results suggest that fixed treatment duration therapy allows patients to experience off-therapy economic benefits. Further exploration should be undertaken in a larger cohort of patients.